It is the responsibility of all health care providers, including doctors, to begin tracing sex partners so that they can be assessed and treated.
This involves counselling to ensure that the patient understands the implications of transmission of the infection.
Managing sex partners may require referral to another practitioner.
Donovanosis is not highly contagious, but reasonable efforts should be made to examine sex partners.
Review the ulcer each week if possible. It is essential that the lesion be re-examined at four weeks after commencement of treatment.
- If there is no response to treatment at four weeks, consider a biopsy to investigate other causes, i.e. malignancy.
- If the lesion has healed, no further treatment is required.
- If the lesion has improved but not yet healed a further two weeks of treatment should be given (weeks five and six). However, if the lesion has not healed by week six, a biopsy should be considered.
Follow-up at three and six months after the lesion has healed is recommended to ensure that relapse does not occur.
If the patient has had a poor response, consider another diagnosis (e.g. carcinoma or immunosuppression).
To ensure continuity of care, record follow-up instructions in the patient's medical record.
As part of follow-up of patients with donovanosis, it is essential to:
- assess healing of ulcers and compliance with therapy
- consider hospital admission if response to therapy as an outpatient is inadequate.
This also provides an opportunity to repeat blood tests for syphilis, HIV and HBV.